Supplementary statement for the management of Lymphogranuloma venereum (LGV) cases and contacts

Canadian Guidelines on Sexually Transmitted Infections

Download the alternative format
(PDF format, 42 KB, 3 pages)

Organization: Public Health Agency of Canada

Type: Guidance Statement

Published: 2018-01-10

Cat.: HP40-1/2018-1E-PDF

ISBN: 978-0-660-24300-9

Pub.: 170353

Related Topics

October 2017

This statement is a supplement to the 2010 LGV chapter. It replaces the 2014 supplementary statement. The guidance in this statement should be used in place of the current Diagnosis and Treatment of partners sections of the LGV chapter.

Issue

Since 2004 there have been sporadic LGV outbreaks in Canada, predominantly in men who have sex with men (MSM). These have been confined to major urban centres in the provinces of Alberta, British Columbia, Ontario and Québec.

  • In Canada, the United States, and Europe, the subpopulation at highest risk of LGV is MSM—particularly those who are infected with hepatitis C (HCV), HIV or other STIs, and those who engage in unprotected anal or oral group sex.
  • National enhanced surveillance of LGV was conducted from 2004-2012. During this time, 104 confirmed and 66 probable cases were reported to the Public Health Agency of Canada by the provinces and territories.

Screening and diagnostic testing

  • The diagnosis of LGV is not always straightforward, and is often based on the history and clinical presentation, supported by laboratory testing.
  • Clinicians should have a high index of suspicion for LGV if a patient presents with consistent signs/symptoms (e.g., proctitis and/or marked inguinal or femoral lymphadenopathy or buboes) AND/OR if patient history suggests exposure.
  • Commercial NAATs are approved in Canada for C. trachomatis testing of urethral, cervical and vaginal swabs, and for urine. However, current literature indicates that NAATs can be used to detect rectal and oropharyngeal infections if performance specifications have been established for the assay in use.Footnote 1,Footnote 2
  • Serology is not recommended for the diagnosis of non-LGV and LGV genital chlamydia infections, given cross-reactions with other chlamydia species, and difficulties interpreting variations in titres.

Diagnostic procedures/specimen collection

  • Collect the following specimens, as clinically indicated for the detection of C. trachomatis using NAAT/culture:
    • swab of the lesion (if present);
    • first-void urine;
    • urethral, cervical, vaginal, rectal, and/or oral swabs;
    • fluid from buboes (if present).

LGV genotyping for C. trachomatis positive results

Definitive diagnosis of LGV requires serovar-specific testing (i.e., genotyping). This testing is only available through provincial/territorial laboratories or the National Microbiology Laboratory (NML).

  • For symptomatic individuals and sexual partners of individuals diagnosed with LGV, request that C. trachomatis-positive specimens be forwarded to the provincial/territorial laboratory or the NML for LGV genotyping.
  • For asymptomatic MSM presenting with risk factors for LGV, consider requesting that C. trachomatis-positive rectal specimens be forwarded to the provincial/territorial laboratory or the NML for LGV genotyping.
    • Published data on LGV in MSM have found that when C. trachomatis is identified in urogenital specimens, few samples test positive for LGV.Footnote 3,Footnote 4,Footnote 5,Footnote 6
    • A 2017 study conducted in the Netherlands found that a high proportion of chlamydia-positive rectal specimens tested positive for LGV in asymptomatic MSM,Footnote 5 in contrast to findings from earlier studies where rectal LGV was primarily identified in symptomatic patients.Footnote 2,Footnote 3,Footnote 4,Footnote 7

Treatment of suspected, probable and confirmed cases

Suspected, probable and confirmed cases should receive treatment for LGV as per the recommendations in Table 4 of the LGV chapter.

  • Suspect LGV if patient presents with proctitis, or inguinal or femoral lymphadenopathy, or buboes, or if patient history suggests exposure.
  • A probable case is defined as any individual with:
    • a positive C. trachomatis test result by NAAT or culture PLUS the presence of proctitis or inguinal or femoral lymphadenopathy;

      OR

    • a sexual partner with LGV.
  • A confirmed case is defined as any individual testing positive for C. trachomatis by NAAT or culture confirmed to be serovar L1, L2 or L3.

Treatment of partners

  • Sexual partners of confirmed or probable cases should be tested and empirically treated for LGV.
  • Sexual partners of individuals testing positive for non-LGV C. trachomatis who are not considered high risk for LGV themselves, should be tested and empirically treated with an effective regimen for the treatment of non-LGV chlamydia [C-lll] as outlined in Table 3 of the Chlamydial Infections chapter.

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2017

Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: